Objective  Based on clinical prescription data mining, this study aimed to compare the clinical medication rules of Rhizoma Alismatis (Zexie) and salt-processed Rhizoma Alismatis (Yanzexie), to provide clinical evidence for the processing theory of "salt processing directing the herb to act on the kidney", and to guide the rational application of processed Rhizoma Alismatis products.

Methods  Outpatient prescriptions of Chinese herbal pieces containing Rhizoma Alismatis or salt-processed Rhizoma Alismatis issued in 2023 by the Affiliated Hospital of Jiangxi University of Chinese Medicine were retrospectively extracted (with a 1% proportional sampling). The Ancient and Modern Medical Records Cloud Platform (V2.3.8) was used for basic information statistics (gender, age, dosage), prescription characteristic analysis (four natures and five flavors, meridian tropism, efficacy, disease-syndrome distribution), and data mining (frequency statistics, Chinese medicine attribute analysis, association rule analysis, cluster analysis, complex network analysis).

Results  After screening, 473 valid prescriptions were included, comprising 100 prescriptions with Rhizoma Alismatis and 373 with Salt-processed Rhizoma Alismatis. Disease distribution showed the top three conditions for Rhizoma Alismatis prescriptions were acne, skin diseases, and seborrheic alopecia, while for Salt-processed Rhizoma Alismatis prescriptions they were menstrual disorders, dizziness, and kidney system diseases. Rhizoma Alismatis prescriptions were predominantly for damp-heat syndrome, whereas Salt-processed Rhizoma Alismatis prescriptions were primarily for spleen deficiency and spleen-kidney deficiency syndromes. Regarding herb combinations, the core pair for both was "Rhizoma Alismatis/Salt-processed Rhizoma Alismatis-Poria (Fu Ling)". A unique pair in Rhizoma Alismatis prescriptions was "Rhizoma Alismatis - Phellodendron Bark (Huang Bai) (32%)" (clearing heat), while for Salt-processed Rhizoma Alismatis it was "Salt-processed Rhizoma Alismatis - Chinese Yam (Shan Yao) (33.78%)" (tonifying the kidney). In the distribution of the four natures, the top three for Rhizoma Alismatis prescriptions were cold (28.54%), warm (21.19%), and neutral (21.04%); for Salt-processed Alisia, they were neutral (26.83%), warm (21.44%), and cold (16.98%). The cold property clears heat and drains dampness, while the neutral and warm properties tonify and supplement, aligning with their respective primary syndromes. Complex network analysis revealed the core drug composition for Rhizoma Alismatis prescriptions: Rhizoma Alismatis, Poria, Licorice (Gan Cao), Phellodendron Bark, Vinegar-fried Bupleurum (Cu Bei Chai Hu), Atractylodes (Bai Zhu), Bran-fried Atractylodes (Fu Chao Cang Zhu), Chinese Angelica (Dang Gui), Rehmannia (Sheng Di Huang), White Peony (Bai Shao). For Salt-processed Rhizoma Alismatis prescriptions, the core composition was: Salt-processed Rhizoma Alismatis, Poria, Rehmannia, Astragalus (Huang  Qi), Codonopsis (Dang Shen), Moutan Bark (Mu Dan Pi), Cornus (Shan Zhu Yu), Vinegar-fried Bupleurum, Chinese Yam, Atractylodes, Chinese Angelica. Rhizoma Alismatis prescriptions were derived from formulas like Xiaoyao San, Ermiao San, and Shaoyao Gancao Tang, aligning with the dominance of damp-heat syndrome and the high proportion of cold-property herbs, focusing on "clearing heat and draining dampness + soothing the liver and harmonizing blood". Salt-processed Rhizoma Alismatis prescriptions were based on formulas like Liuwei Dihuang Tang and Sijunzi Tang, adapted for "spleen-kidney deficiency syndrome", consistent with the neutral-property dominance, focusing on "tonifying the kidney and strengthening the spleen+promoting diuresis and nourishing yin".

Conclusion  This study, through the analysis of outpatient prescriptions containing Rhizoma Alismatis or Salt-processed Rhizoma Alismatis, clarifies their differences in medication patterns. Rhizoma Alismatis prescriptions primarily treat excess damp-heat patterns, focusing on clearing heat, draining dampness, soothing the liver, and harmonizing blood. Salt-processed Rhizoma Alismatis prescriptions primarily treat spleen-kidney deficiency patterns, emphasizing tonifying the kidney, strengthening the spleen, promoting diuresis, and nourishing yin. While both share the core herb pair "Rhizoma Alismatis-Poria", they differ in disease patterns, compatibility, and herbal properties, demonstrating a shift from "clearing heat in excess patterns" to "tonifying deficiency in deficiency patterns", embodying the variation based on pattern differentiation. These findings can provide guidance and reference for clinical medication.

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